Abstract
Background The American Geriatrics Society recommends against the use of certain potentially
inappropriate medications (PIMs) in older adults. Prescribing of these medications
correlates with higher rates of hospital readmissions, morbidity, and mortality. Vanderbilt
University Medical Center previously deployed clinical decision support (CDS) to decrease
PIM prescribing rates, but recently transitioned to a new electronic health record
(EHR).
Objective The goal of this study was to evaluate PIM prescribing rates for older adults before
and after migration to the new EHR system.
Methods We reviewed prescribing rates of PIMs in adults 65 years and older, normalized per
100 total prescriptions from the legacy and new EHR systems between July 1, 2014 and
December 31, 2019. The PIM prescribing rates before and after EHR migration during
November 2017 were compared using a U-chart and Poisson regression model. Secondary
analysis descriptively evaluated the frequency of prescriber acceptance rates in the
new EHR.
Results Prescribing rates of PIMs decreased 5.2% (13.5 per 100 prescriptions to 12.8 per
100 prescriptions; p < 0.0001) corresponding to the implementation of alternatives CDS in the legacy EHR.
After migration of the alternative CDS from the legacy to the new EHR system, PIM
prescribing rates dropped an additional 18.8% (10.4 per 100 prescriptions; p < 0.0001). Acceptance rates of the alternative recommendations for PIMs was low overall
at 11.1%.
Conclusion The prescribing rate of PIMs in adults aged 65 years and older was successfully decreased
with the implementation of prescribing CDS. This decrease was not only maintained
but strengthened by the transition to a new EHR system.
Keywords
electronic health records - clinical decision support - electronic prescribing - geriatrics
- potentially inappropriate medication
